Skip to main content
Log in

The Impact of Microprocessor Knees on the Cognitive Burden of Ambulation, Patient Safety, Healthcare Economics, and Prosthetic Mobility

  • Amputation Rehabilitation (JM Cohen, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this paper is to highlight significant publications from the last 5 years relative to the impact of microprocessor knees (MPKs) on such considerations as the cognitive loads experienced during prosthetic ambulation, patient safety and the mitigation of fall risk, healthcare economic models, and prosthetic mobility.

Recent Findings

Recent publications have linked the use of an MPK with a reduction in the self-reported cognitive demands of ambulation, a substantially reduced risk of injurious falls among individuals with dysvascular amputation etiology, and enhanced prosthetic mobility in both community and limited community ambulators. Reduced fall risk and enhanced quality of life have culminated in substantial impacts of MPKs on healthcare economic models. There is a growing recognition of the potential value of MPKs among prosthesis users confined to limited community ambulation.

Summary

The evidence in support of MPKs has continued to mature in recent years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Stevens PM, Wurdeman SR. Prosthetic knee selection for individuals with unilateral transfemoral amputation: a clinical practice guideline. J Pros Orthot. 2019;31(1):2. Recent Clinical Practice Guideline based on multiple systematic reviews.

  2. Morgan SJ, Hafner BJ, Kartin D, Kelly VE. Dual-task standing and walking in people with lower limb amputation: a structured review. Prosthet Orthot Int. 2018 Dec;42(6):652–66.

    Article  Google Scholar 

  3. Hafner BJ, Smith DG. Differences in function and safety between Medicare Functional Classification Level-2 and −3 transfemoral amputees and influence of prosthetic knee joint control. J Rehabil Res Dev. 2009;46(3):417–33.

    Article  Google Scholar 

  4. •• Möller S, Rusaw D, Hagberg K, Ramstrand N. Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking. Pros Orthot Int. 2019;43(3):257–65. First objective measure of cognitive load during prosthetic ambulation demonstrating differences between prosthetic knee types.

  5. Kahle JT, Highsmith MJ, Hubbard SL. Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. J Rehabil Res Dev. 2008;45(1):1–14.

    Article  Google Scholar 

  6. Balk EM, Gazula A, Markozannes G, Kimmel HJ, Saldanha IJ, Resnik LJ, Trikalinos TA. Lower limb prostheses: measurement instruments, comparison of component effects by subgroups, and long-term outcomes. Comparative Effectiveness Review, No.213 Rockville (MD): Agency for Healthcare Research and Quality (US); 2018.

  7. •• Wurdeman S, Miller T, Stevens P, Campbell JH. Microprocessor knee technology reduces odd of incurring an injurious fall for diabetic/dysvascular amputees, Am J Phy Med Rehabil. 2020;99(3):a6. Large retrospective analysis of fall history among individuals with transfemoral amputation due to dysvascular disease or diabetes according to their use of an MPKs vs as nMPKs.

  8. Kannenberg A, Zacharias B, Pröbsting E. Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: systematic review. J Rehabil Res Dev. 2014 Nov 30;51(10):1469.

    Article  Google Scholar 

  9. Kaufman KR, Bernhardt KA, Symms K. Functional assessment and satisfaction of transfemoral amputees with low mobility (FASTK2): a clinical trial of microprocessor-controlled vs. non-microprocessor-controlled knees. Clin Biomech. 2018;58:116–22.

    Article  Google Scholar 

  10. Centers for Medicare & Medicaid Services Health Technology Assessment Lower Limb Prosthetic Workgroup Consensus Document. Accessed on 4/20/2021 at https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/LLP_Consensus_Document.pdf

  11. Webster JB, Crunkhorn A, Sall J, Highsmith MJ, Pruziner A, Randolph BJ. Clinical practice guidelines for the rehabilitation of lower limb amputation: an update from the Department of Veterans Affairs and Department of defense. Am J Phys Med Rehabil. 2019;98(9):820–9.

    Article  Google Scholar 

  12. Thiele J, Schollig C, Bellmann M, et al. Designs and performance of three new microprocessor-controlled knee joints. Biomed Tech (Berl). 2019;64(119–126):10.

    Google Scholar 

  13. Bellmann M, Kohler TM, Schmalz T. Comparative biomechanical evaluation of two technologically different microprocessor-controlled prosthetic knee joints in safety-relevant daily-life situations. Biomed Tech (Berl). 2019;64:407–20.

    Article  Google Scholar 

  14. Prinsen EC, Nederhand MJ, Olsman J, et al. Influence of a user-adaptive prosthetic knee on quality of life, balance confidence, and measures of mobility: a randomized cross-over trial. Clin Rehabil. 2015;29:581–91.

    Article  Google Scholar 

  15. Hafner BJ, Askew RL. Physical performance and self-report outcomes associated with use of passive, adaptive, and active prosthetic knees in persons with unilateral, transfemoral amputation: Randomized crossover trial. J Rehabil Res Dev. 2015;52:677–700.

    Article  Google Scholar 

  16. • Campbell JH, Stevens PM, Wurdeman SR. OASIS 1: Retrospective analysis of four different microprocessor knee types. J Rehab Assist Technol Eng. 2020;7:2055668320968476. Largest independent analysis of comparative efficacy of different MPKs.

  17. Mundell B, Kremers HM, Visscher S, et al. Direct medical costs of accidental falls for adults with transfemoral amputations. Prosthet Orthot Int. 2017;41(6):564–70.

    Article  Google Scholar 

  18. Chen C, Hanson M, Chaturvedi R, Mattke S, Hillestad R, Liu HH. Economic benefits of microprocessor controlled prosthetic knees: a modeling study. J Neuroeng Rehabil. 2018;15(Suppl 1):62. https://doi.org/10.1186/s12984-018-0405-8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kuhlmann A, Krüger H, Seidinger S, Hahn A. Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus. Eur J Health Econ. 2020;21(3):437–49.

    Article  Google Scholar 

  20. Cutti AG, Lettieri E, Del Maestro M, Radaelli G, Luchetti M, Verni G, Masella C. Stratified cost-utility analysis of C-leg versus mechanical knees: findings from an Italian sample of transfemoral amputees. Prosthet Orthot Int. 2017;41(3):227–36.

    Article  Google Scholar 

  21. Kaufman KR, Levine JA, Brey RH, McCrady SK, Padgett DJ, Joyner MJ. Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Arch Phys Med Rehabil. 2008;89(7):1380–5.

    Article  Google Scholar 

  22. Gerzeli S, Torbica A, Fattore G. Cost utility analysis of knee prosthesis with complete microprocessor control (C-leg) compared with mechanical technology in trans-femoral amputees. Eur J Health Econ. 2009;10(1):47–55.

    Article  Google Scholar 

  23. Seelen HA, Hemmen B, Schmeets AJ, Ament AJ, Evers SM. Costs and consequences of a prosthesis with an electronically stance and swing phase controlled knee joint. Technol Disabil. 2009;21(1–2):25–34.

    Article  Google Scholar 

  24. • Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of amputees (MAAT 3): matching individuals based on comorbid health reveals improved function for above-knee prosthesis users with microprocessor knee technology. Assist Technol. 2018. Largest analysis of the influence of prosthetic knee type on prosthetic mobility.

  25. Hafner BJ, Morgan SJ, Abrahamson DC, Amtmann D. Characterizing mobility from the prosthetic limb user’s perspective: use of focus groups to guide development of the Prosthetic Limb Users Survey of Mobility. Prosthet Orthot Int. 2016;40(5):582–90.

    Article  Google Scholar 

  26. Hafner BJ, Gaunaurd IA, Morgan SJ, Amtmann D, Salem R, Gailey RS. Construct validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M) in adults with lower limb amputation. Arch Phys Med Rehabil. 2017;98(2):277–85.

    Article  Google Scholar 

  27. Lansade C, Vicaut E, Paysant J, Ménager D, Cristina MC, Braatz F, Domayer S, Pérennou D, Chiesa G. Mobility and satisfaction with a microprocessor-controlled knee in moderately active amputees: a multi-centric randomized crossover trial. Ann Phys Rehabil Med. 2018;61(5):278–85.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Phillip M. Stevens.

Ethics declarations

Conflict of Interest

The author declares no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Amputation Rehabilitation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stevens, P.M. The Impact of Microprocessor Knees on the Cognitive Burden of Ambulation, Patient Safety, Healthcare Economics, and Prosthetic Mobility. Curr Phys Med Rehabil Rep 9, 195–199 (2021). https://doi.org/10.1007/s40141-021-00327-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-021-00327-2

Keywords

Navigation